Provider Demographics
NPI:1720077019
Name:JEAN-PIERRE, LISSA M (MD)
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:M
Last Name:JEAN-PIERRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 NW 10TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6537
Mailing Address - Country:US
Mailing Address - Phone:954-648-8999
Mailing Address - Fax:
Practice Address - Street 1:13220 BELCHER RD S UNIT 1
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1677
Practice Address - Country:US
Practice Address - Phone:727-351-4894
Practice Address - Fax:727-351-4897
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85417208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260573200Medicaid
FL260573200Medicaid
H77996Medicare UPIN